Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial

Johannes R Anema, Ivan A Steenstra, Paulien M Bongers, Henrica C W de Vet, Dirk L Knol, Patrick Loisel, Willem van Mechelen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

STUDY DESIGN: Population-based randomized controlled trial.

OBJECTIVE: To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).

SUMMARY OF BACKGROUND DATA: Effective components for multidisciplinary rehabilitation of LBP are not yet established.

METHODS: Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.

RESULTS: Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect.

CONCLUSION: Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.

Original languageEnglish
Pages (from-to)291-8; discussion 299-300
JournalSpine
Volume32
Issue number3
DOIs
Publication statusPublished - 1 Feb 2007

Cite this

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title = "Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial",
abstract = "STUDY DESIGN: Population-based randomized controlled trial.OBJECTIVE: To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).SUMMARY OF BACKGROUND DATA: Effective components for multidisciplinary rehabilitation of LBP are not yet established.METHODS: Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.RESULTS: Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95{\%} CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95{\%} CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect.CONCLUSION: Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.",
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Multidisciplinary rehabilitation for subacute low back pain : graded activity or workplace intervention or both? A randomized controlled trial. / Anema, Johannes R; Steenstra, Ivan A; Bongers, Paulien M; de Vet, Henrica C W; Knol, Dirk L; Loisel, Patrick; van Mechelen, Willem.

In: Spine, Vol. 32, No. 3, 01.02.2007, p. 291-8; discussion 299-300.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Multidisciplinary rehabilitation for subacute low back pain

T2 - graded activity or workplace intervention or both? A randomized controlled trial

AU - Anema, Johannes R

AU - Steenstra, Ivan A

AU - Bongers, Paulien M

AU - de Vet, Henrica C W

AU - Knol, Dirk L

AU - Loisel, Patrick

AU - van Mechelen, Willem

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AB - STUDY DESIGN: Population-based randomized controlled trial.OBJECTIVE: To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).SUMMARY OF BACKGROUND DATA: Effective components for multidisciplinary rehabilitation of LBP are not yet established.METHODS: Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.RESULTS: Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect.CONCLUSION: Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.

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KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Low Back Pain/epidemiology

KW - Male

KW - Middle Aged

KW - Occupational Diseases/epidemiology

KW - Occupational Health Services/methods

KW - Sick Leave

KW - Single-Blind Method

KW - Workplace

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SN - 0362-2436

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